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Republic of Serbia Republic of Serbia National AIDS Commission, Ministry of Health of Serbia, Institute of Public Health of Serbia “Dr Milan Jovanovic Batut” Reporting period: January 2010 – December 2011 Status at a glance 3 Overview of the HIV epidemic 10 National Response to the HIV epidemic 15 Major challenges faced and actions needed to achieve the goals/targets19 Support required from country’s development partners 20 Monitoring and evaluation environment 21 Annex 1: Consultation/preparation process for this national report 24 Status at a glance Strategic, Policy, and Programmatic Framework The Republic of Serbia is a democratic state located in the central part of the Balkan Peninsula, on the most important route linking Europe and Asia. The Republic of Serbia is middle income country with unemployment rate that has reached 19.2 percent in 2010. Belgrade is the capital of Serbia. With a population of 1,576,124 million, it is the country's administrative, economic and cultural centre. It is estimated that almost 24% of the population in Serbia reside in the four key cities of Belgrade, Novi Sad, Nis and Kragujevac. Serbia has 7.5 million inhabitants, primarily characterized by continuing trends of low birth rates and population ageing. According to the most recent census (2002), projected share of elderly persons (65 years and above) was 17.4% in 2008, while persons aged 20 to 39 projected for 27.18%. Over the previous decade, the population in Serbia is growing older, has longer life expectancy, and is decreasing in volume. In 2010, an estimated number of citizens of the Republic of Serbia (excluding Kosovo under UN resolution 1244) were 7,291,346. This compared to data from 2002, when there were 7,516,346 citizens, represents a population decrease of 2.6%. The health status of the Serbian population is consistent with other Central and Eastern European countries but below that of Western Europe. Serbia compares well with similar countries in terms of life expectancy at birth (72.3 years). In terms of principal causes of death, the picture is similar to many developed and transitional economies with high levels of heart disease, stroke, and cancer. Smoking is estimated to be linked to 30% of mortality in Serbia. Poor nutrition and poor diet are also major risk factors. In the past 10 years Serbian society has experienced major changes in moral, cultural, social, economic and general life values and has had to overcome many challenges. All these contribute to public lack of interest and certain intolerance in relation to vulnerable groups. Much work is dedicated to fighting stigma and discrimination, both in the projects, but also through activities of other stakeholders; however results are not yet encouraging. After the overall changes in the society in 2000 and as a follow up of the responsibilities undertaken with the adoption of the Declaration of Commitment on HIV/AIDS at the UN General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001, the Government of the Republic of Serbia established its National HIV/AIDS Commission (NAC) in March 2002, which had been newly re-established in June 2004 and revised in 2008. NAC is the governmental multisectorial body with Ministry of Health as Coordinator and comprises of president and 21 members, including representatives from the Ministries of Health, Interior Affair, Justice, Education, Labor and Social Policy, Youth and Sport, as well as, representatives from Regional and local health authorities, Red Cross of Serbia, NGOs; PLHIV; academic institutions; public medical institutions/organizations, media and also observers from UN agencies (WHO, UNAIDS, UNICEF, UNDP). NAC is tasked to formulate strategic directions for fight against HIV/AIDS, and to define priority activities and coordinate programs and projects dealing with the disease. NAC is currently in the process of reconstruction which is expected to reflect new political context as well as goals defined in the Strategy. Page 3 of 23 The low prevalence rate and socially conservative values mean that HIV/AIDS is still a low profile issue in Serbia. Its low ratings on the health and social agendas understandably restrict the level of resources. The Government of Serbia designed and developed the national response on HIV and AIDS in line with international standards and approaches. It follows the “Three Ones” principles, establishing a single action framework (National Strategy) and a single country wide M&E system. Government also established a single National AIDS coordinating authority. The assumptions underlying the “Three Ones” approach is that HIV/AIDS is a development issue and requires a multi-sectorial response that is integrated into the national development agenda and many strategic documents. After the broad public debates and consulations with various stakeholders about the most important issues which were conducted throughout the country the new National HIV Strategy for the period 2011-2015 is adopted at March 2011 by the Government of Republic of Serbia. The Strategy is in line with Joint UNAIDS HIV/AIDS Strategy for 2011-2015, the Global Health Sector Strategy for HIV/AIDS 2011-2015, European Commission Communication on combating HIV/AIDS in EU and neighboring countries 2009-2015, Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia 2004 and other relevant international documents. The general goal of the National Strategy for response on HIV and AIDS in Serbia are prevention of HIV infection and other sexually transmitted infections, and providing treatment and support to all people living with HIV. The Strategy recognizes 7 strategic areas: prevention; health and social protection of people living with HIV (PLHIV); support to people living with HIV; role of local community in the response to HIV; protection of human rights; communication in the area of HIV; and, epidemiological surveillance, monitoring, evaluation and reporting on the national response to the HIV epidemic. Under the strategic area Prevention, Strategy recognize different measurements and activities related to: voluntary counseling and testing; prevention among PLHIV (positive prevention); prevention among most at risk population (such as sex workers, men who have sex with men, injecting drug users, prisoners, uniformed persons, youth – especially those vulnerable on HIV, etc); and, prevention of blood transmitted infections in health facilities. The objectives of preventive programs are, generally: • Lowering the number of newly infected and early diagnosis of HIV infections; • Maintaining a low STI incidence rate; • Increase in coverage of preventive services and increase in quality of the provided services; • Creating conditions within state authorities and institutions, and citizen associations for highly efficient response to persons living with the risk for the purposes of reducing this risk. Further, area of Health and social protection of HIV infected persons includes: • Improvement of life quality of PLHIV; • Creating conditions for early diagnosis of HIV infected persons resulting in successful treatment, including timely treatment of children born of HIV infected mothers; • Continued improvement of quality of provided health care services at all levels; • Securing conditions for timely laboratory testing to monitor successfulness of antiretroviral treatment in PLHIV. Area of Support to people living with HIV includes: Page 4 of 23 • Recognizing, strengthening capacity and involvement of PLHIV, other civil society organizations and Red Cross in response to HIV epidemic; • Improving quality of services to PLHIV; • Improving quality of life of PLHIV by increased accessibility of health services, care and support to PLHIV and their families. Area of Role of local authorities in response to HIV infection epidemic includes: • Increase of accessibility and coverage of services related to prevention and control of HIV infection and providing support to PLHIV in local communities; • Strengthening of systematic, continued and planned multi-sect oral response of local communities to HIV epidemic. Area of Human rights in the area of HIV includes: • Adhere to, protect and promote human rights of PLHIV. • Adhere to, protect and promote human rights of other sensitive and marginalized social groups • Lowering social, legal, cultural and socio-economic vulnerability with securing comprehensive participation of PLHIV and other marginalized and vulnerable groups in response to the HIV epidemic. • Creating discrimination and stigmatization free environment for PLHIV and other vulnerable and marginalized groups. Area of Communication in the area of HIV includes: • Improving health communication in the response to HIV infection in the field of prevention • Improving communication with the purpose of lowering stigma and discrimination related to HIV infection. Area of the monitoring, evaluation and reporting include: • Timely and adequate reaction to the current epidemiological situation. • Defining effective Benchmarks of HIV infection control supported by evidence on all levels, through securing appropriate data for continued follow-up of epidemiological situation and trends • Improvement of institutionalized network for data gathering and analysis on the level of Republic/province/region • Improvement of the system for monitoring and evaluation of successfulness of comprehensive response to HIV infection epidemic • Development of research capacity of institutions, associations and individuals and support to researches in the
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